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On October 10, 2020, the Memorial Sloan Kettering Cancer Center Supportive Care Service hosted their first-ever United States (US) World Hospice and Palliative Care Day (WHPCD) Celebration. The purpose of this article is to describe the US inaugural event in alignment with the broader goals of WHPCD and provide lessons learned in anticipation of the second annual conference to be held on October 5–6, 2021.
Description of the inaugural event in the context of COVID-19 and WHPCD, co-planning conference team reflection, and attendee survey responses.
The Worldwide Hospice Palliative Care Alliance initially launched WHPCD in 2005 as an annual unified day of action to celebrate and support hospice and palliative care around the world. The US-based innovative virtual conference featured 23 interprofessional hospice and palliative care specialists and patient and family caregiver speakers across nine diverse sessions addressing priorities at the intersection of COVID-19, social injustice, and the global burden of serious health-related suffering. Two primary aims guided the event: community building and wisdom sharing. Nearly 270 registrants from at least 16 countries and one dozen states across the US joined the free program focused on both personal and professional development.
Significance of results
Unlike many other academic conferences and professional gatherings that were relegated to online forums due to pandemic-related restrictions, the US WHPCD Celebration was intentionally established to create a virtual coming together for collective reflection on the barriers and facilitators of palliative care delivery amid vast societal change. The goal to ensure a globally relevant and culturally inclusive agenda will continue to draw increased participation at an international level during future annual events. Finally, the transparent and respectful sharing of palliative care team experiences in the year preceding the conference established a safe environment for both individual expression and scholarly discussion.
Interventional neuroradiology (INR) has evolved from a hybrid mixture of daring radiologists and iconoclastic neurosurgeons into a multidisciplinary specialty, which has become indispensable for cerebrovascular and neurological centers worldwide. This manuscript traces the origins of INR and describes its evolution to the present day. The focus will be on cerebrovascular disorders including aneurysms, stroke, brain arteriovenous malformations, dural arteriovenous fistulae, and atherosclerotic disease, both intra- and extracranial. Also discussed are cerebral vasospasm, venolymphatic malformations of the head and neck, tumor embolization, idiopathic intracranial hypertension, inferior petrosal venous sinus sampling for Cushing’s disease, and spinal interventions. Pediatric INR has not been included and deserves a separate, dedicated review.
Compulsory admission to psychiatric hospital in the United Kingdom (UK) is governed by the Mental Health Act (MHA). There have been concerns that the application of this legislation may be discriminatory, and that there is a trend towards increasing use of coercion.
Aims and objectives:
To evaluate data on MHA assessments in order to determine overall outcomes; and whether there is evidence for a difference in outcomes based on variables such as age, gender, or ethnic group.
A database including around 99% of all such assessments was compiled from information recorded routinely at the time of the assessments by senior social workers who lead the assessments. This was analysed using SPSS statistical software.
There were clear statistical correlations with a number of variables including marital status, living alone and age. There was a slight but significant bias towards using shorter detention periods of up to 28 days for women, rather than longer up to six-month periods. However, despite this there was no overall evidence of gender bias.
This is the largest such study in the published literature and provides clear evidence of outcomes and trends in the use of coercive powers under the Mental Health Act in Norfolk, United Kingdom.
There is scant data about mental disorders among nursing students from Nepal though it is reported high in other parts.
To measure prevalence of psychiatric problems and to determine common stressors among nursing students
This institute based prevalence study included all certificate and bachelor level nursing students of B. P. Koirala Institute of Health Sciences, Nepal during 2011/12. After informed written consent, ‘semi-structured proforma’, ‘General Health Questionnaire 28’ and ‘Gurmeet Singh's Presumptive stressful life events scale’ were distributed to record sociodemographic/ clinical profiles and other relevant information; to screen psychiatric disorder and to study the stressors respectively. The ‘General Health Questionnaire 28’ gives ‘psychiatric caseness’ to subjects with score 4 or more.
Out of total 200 nursing students, 185 could be enrolled during study period. All subjects were female. They were studying in certificate and in BSc. nursing programs in different academic years. Majority were unmarried, less than 25 years of age, were from urban settings and from nuclear family. Among the enrolled subjects, ‘psychiatric caseness’ was present in 88 (47.57%) subjects, with cut off score of 4. The most common stressful events reported from the ‘Gurmeet Singh's Presumptive stressful life events scale’ were related to exam, study and accommodation to institute life, and average total score of the presumptive stress was 164.8 (minimum 0, maximum 706) in last year.
Many nursing students suffer from psychological problems and experience the stress, common stressor being related with nursing education.
In 2007 the United Kingdom amended Mental Health Act legislation. This was driven by a public outcry over homicides perpetrated by mentally ill offenders. There was a very large and unsuccessful campaign against these changes led by the Royal College of Psychiatrists. One of the central objections to the changes was the belief that the amended Act would introduce new criteria for detention that would result in a rise in the number of detentions.
Objectives and Aims
To measure whether there was any change in outcomes associated with the amended criteria for detention.
Data is routinely collected in the county of Norfolk on over 99% of all assessments for possible detention. Data covering the period 2001 – 2011 covering 11505 (7885 pre amendments and 3620 post amendments) individual assessments for possible detention was analysed as part of the Norfolk Mental Health Act Assessments Outcomes Study. Outcomes measures were the number of admissions and the number of detentions that followed from Mental Health Act assessments.
There was a highly significant 27% rise (p 0.000) in the proportion of people detained and a 16% fall (p 0.000) in the proportion of people admitted voluntarily following Mental Health Act assessments under the new amended Act.
The changes to the law appear to have led to approximately 33 people being detained every year in Norfolk who would not previously have been detained. If extrapolated to the whole of England this would amount to over 1500 additional annual detentions.
A significant number of people are not detained in hospital following assessment under the Mental Health Act 1983 (MHA) for possible detention. However, since amendments in 2007, some studies show an increase in total patient detentions. There is currently a lack of published research describing both outcomes and their affecting variables.
To determine rates, outcomes and affecting variables of MHA assessments in Norfolk, 2001–2011.
This observational study involved data collection from all 11,509 referrals for detention assessment under the MHA. Data was collected by Norfolk Social Services from 2001–2011 including age, gender and marital status.
Following assessment, 6903 (60.0%) were admitted; of those, 1157 (16.8%) were voluntary and 5746 (83.2%) were detained; 4606 (40%) were not admitted. Admission rates for males (50.4%) and females (49.5%) were similar. Detention rates increased with age: 37.6% of < 18s; 47.1% of 18–64s and 61.4% of 65+. A greater proportion of married (57.5%) and widowed patients (58.2%) were detained, compared with patients who were single (48%). Accommodation status showed 52% of those living with other were detained versus 43.9% of those with no fixed abode.
The finding that a higher proportion of married than single people, and of those living with others versus living alone, were detained following assessment is unexpected but significant and needs further investigation.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
The Mental Health Act (MHA) 2007 made some significant changes from the Mental Health Act 1983, including the fact that detention is now only allowed if an appropriate medical treatment is available to the patient at the time . There was considerable concern at the time that the 2007 Act would lead to an increase in detentions.
The primary objective is to assess how the change in the English law with the MHA 2007 has affected the number of detentions under the MHA.
A retrospective, observational and noninterventional study used anonymised and routinely collected data regarding 11,509 people who were formally assessed under the Mental Health Act during the period of 2001–2011 in the county of Norfolk. This included 7885 assessments before the 2007 MHA and 3620 done after implementation.
The proportion of people detained following assessment decreased from 53.2% before the 2007 MHA to 42.9% after implementation (P = .000). The total proportion of patients admitted (whether informally or detained) also decreased from 63.3% before the 2007 MHA to 52.8% thereafter (P = .000).
These results show a significant decrease in the rate of detentions under the MHA since the 2007 Act became law.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
In this paper, a high gain wideband circularly polarized (CP) microstrip antenna is presented for broadband operation. The proposed structure comprised of a partially grounded printed monopole antenna loaded with a split ring resonator and a metallic reflector. By using the metallic reflector surface underneath the patch radiator results in the reflected waves in the same phase with main lobe radiation, thereby improving the gain and it also acts like a secondary radiator to generate wideband CP behavior in the proposed design. A gain enhancement of 4.3 dBi is achieved in the operating frequency band as compared with the design without a metallic reflector. The maximum gain achieved in the presented method is 8.6 dBic over the entire operating range. The proposed design shows a wideband behavior ranging from 4.30 to 9.10 GHz with the 10-dB impedance bandwidth of 71.64%. In addition, the proposed design yielded a broadside right hand CP radiation with a 3-dB axial ratio bandwidth of 33.88% from 4.98 to 7.01 GHz. The proposed antenna is fabricated and experimental results on reflection coefficient, gain, axial ratio, and radiation patterns concede well with simulation results.
The eastern Arabian Sea is influenced by both the advection of upwelled water from the western Arabian Sea and winter convective mixing. Therefore, sediments collected from the eastern Arabian Sea can help to understand the long-term seasonal hydrographic changes. We used the planktonic foraminifera census and stable isotopic ratio (δ18O) from sediments drilled during the International Ocean Discovery Program Expedition 355 to reconstruct surface hydrographic changes in the eastern Arabian Sea during the last 350 kyr. The increased abundance of Globigerina bulloides suggests enhanced advection of upwelled water during the latter half of MIS7 and the beginning of MIS6, as a result of a strengthened summer monsoon. A large drop in upwelling and/or advection of upwelled water from the western Arabian Sea is inferred during the subsequent interval of MIS6, based on the rare presence of G. bulloides. The comparable relative abundance of Neogloboquadrina dutertrei, G. bulloides and Globigerinoides ruber suggests that during the early part of MIS5, hydrographic conditions were similar to today. The upwelling decreased and winter convection increased with the progress of the glacial interval. A good coherence between planktonic foraminiferal assemblage-based monsoon stacks from both the eastern and western Arabian Sea suggests a coeval response of the entire northern Arabian Sea to the glacial–interglacial changes. The glacial–interglacial difference in δ18Osw-ivc was at a maximum with 4–5 psu change in salinity during Termination 2 and 3, and a minimum during Termination 4. The significantly reduced regional contribution to the glacial–interglacial change in δ18Osw-ivc during Termination 4 suggests a lesser change in the monsoon.
Opioid analgesics are often prescribed following rhinology surgery. This study aimed to evaluate whether the quantity of opioid analgesics prescribed is justified.
Patients were asked about their pain management post-operatively. Parameters recorded included: current pain (using a 10-point Likert scale); type of operation; the opioid analgesics prescribed; and the quantity of opioid tablets taken and other methods of pain relief used.
Thirty-five patients were successfully contacted. The median pain score at one week post-operation was 1 (interquartile range, 0–3). Of these 35 patients, 16 were prescribed opioids, whilst 19 were not. Patients prescribed opioids took a median of 8 tablets (interquartile range, 0.8–10.5) out of the 28 tablets prescribed.
The study shows that the quantity of post-operative opioid analgesics prescribed does not compare with the amount consumed by patients to relieve pain, resulting in a surplus of opioid medication which has the potential to be abused.
A field experiment was conducted to study the long-term effects of nutrient management practices on micronutrient concentrations in soil and their uptake by crops under a long-term rice–wheat cropping system. The treatments comprised different combinations of N, P, K, Zn and farm yard manure (FYM), used as nutrient management practices. After 25 years of continuous cropping, the higher grain yields and uptake of iron (Fe), manganese (Mn), copper (Cu) and zinc (Zn) were obtained when FYM was applied along with mineral sources of nitrogen, phosphorus and potassium (NPK) when compared to mineral sources of NPK alone. The residual effect of FYM, applied to rice, on the yield of subsequent wheat was significant. The application of mineral NPK with FYM recorded higher diethylene triamine penta acetic acid extracted (DTPA)-Fe, Mn and Cu concentrations in the soil compared to any other treatment. The plots with Zn application showed higher DTPA-Zn concentration in the soil compared to any other treatments. The available Fe, Mn and Cu in the soil were higher than their critical limits and the soil was low in Zn where inorganic fertilizers were applied alone (without Zn). Integrated application of mineral NPK and FYM to the rice crop and mineral NPK to wheat was found to be the best nutrient management practice in producing higher yields of rice and wheat and improve long-term soil micronutrient concentrations.
This paper presents a new technique for the enhancement of axial ratio (AR) bandwidth of a circularly polarized dielectric resonator antenna with a single feeding. To enhance the AR bandwidth, adjacent 3-dB AR passbands are merged by inserting the notches and conductive coating in the dielectric resonator. The dimensions of the notches and conductive coating are selected in such manner that impedance bandwidth remains approximately unchanged. The antenna provides the measured AR and impedance bandwidths of 55.22% and 66.45%, respectively.
Using the data obtained from Kepler satellite, we have analyzed an F-type ultra-fast rotator KIC 6791060. We derive a rotational period of 0.34365±0.00004 d. Multiple periodicity with a period separation of ~0.00016 d was detected, which appears to be a result of the relative velocity between the multiple spot-groups in different stellar latitudes due to the surface differential rotation. Modeling of the surface inhomogeneities using the light curve of 3899 epochs shows the evidence of single active longitude region. The active longitude is found to drift along the longitude at a rate similar to the detected period separation of the F-type star. The surface coverage of cool spots is found to be in the range of ~0.07–0.44%. The low value of the spottedness can be interpreted probably due to the thinner convection zone on the F-type star.
Immunoactivation depends upon the antigen potential to modulate T-cell repertoires. The present study has enumerated the effect of 61 kDa recombinant Leishmania donovani co-factor-independent phosphoglycerate mutase (rLd-iPGAM) on mononuclear cells of healthy and treated visceral leishmaniasis subjects as well as on THP-1 cell line. rLd-iPGAM stimulation induced higher expression of interleukin-1β (IL-1β) in the phagocytic cell, its receptor and CD69 on T-cell subsets. These cellular activations resulted in upregulation of host-protective cytokines IL-2, IL-12, IL-17, tumour necrosis factor-α and interferon-γ, and downregulation of IL-4, IL-10 and tumour growth factor-β. This immune polarization was also evidenced by upregulation of nuclear factor-κ light-chain enhancer of activated B cells p50 and regulated expression of suppressor of mother against decapentaplegic protein-4. rLd-iPGAM stimulation also promoted lymphocyte proliferation and boosted the leishmaniacidal activity of macrophages by upregulating reactive oxygen species. It also induced 1·8-fold higher release of nitric oxide (NO) by promoting the transcription of inducible nitric oxide synthase gene. Besides, in silico analysis suggested the presence of major histocompatibility complex class I and II restricted epitopes, which can proficiently trigger CD8+ and CD4+ cells, respectively. This study reports rLd-iPGAM as an effective immunoprophylactic agent, which can be used in future vaccine design.
Molecular categorisation may explain the wide variation in the clinical characteristics of juvenile nasopharyngeal angiofibroma.
Variations in molecular markers in juvenile nasopharyngeal angiofibroma in an Indian population were investigated and compared with global reports.
Variable molecular marker expression was demonstrated at the regional and global levels. A wide variation in molecular characteristics is evident. Molecular data have been reported for only 11 countries, indicating a clear geographical bias. Only 58 markers have been studied, and most are yet to be validated.
Research into the molecular epidemiology of juvenile nasopharyngeal angiofibroma is still in its infancy. Although the molecular variation is not well understood, data obtained so far have prompted important research questions. Hence, multicentre collaborative molecular studies are needed to establish the aetiopathogenesis and establish molecular surrogates for clinical characteristics.
Oocyte-secreted factors (OSFs) play an important role in the acquisition of oocyte developmental competence through bidirectional cross-talk between oocyte and cumulus cells via gap junctions. Thus, the present study was designed to investigate the effect of two OSFs, growth differentiation factor 9 (GDF9) and bone morphogenetic protein 15 (BMP15), on the developmental competence of buffalo oocytes derived from two different follicle sizes. Cumulus–oocyte complexes (COCs) from large follicles (LF, >6 mm) or small follicles (SF, <6 mm) were collected and matured in vitro either in the presence of GDF9 or BMP15, or both, or with the denuded oocytes (DOs) as a source of native OSFs. Cleavage and blastocyst rates were significantly (P < 0.05) higher in LF-derived than SF-derived oocytes. Cleavage and blastocyst rates were significantly higher (P < 0.05) in the DOs and the combination groups compared with the control, GDF9 alone and BMP15 alone groups, both in LF-derived and SF-derived oocytes, although the cleavage and blastocyst rates did not differ significantly (P > 0.05) between DOs and combination groups. Relative mRNA analysis revealed significantly higher (P > 0.05) expression of the cumulus cell marker genes EGFR, HAS2, and CD44 in LF-derived than SF-derived oocyte; the expression of these markers was significantly higher (P > 0.05) in DOs and combination groups, irrespective of the follicle size. These results suggested that LF-derived oocytes have a higher developmental competence than SF-derived oocytes and that supplementation of GDF9 and BMP15 modulates the developmental competence of buffalo oocytes by increasing the relative abundance of cumulus-enabling factors and thereby increasing cleavage and the quality of blastocyst production.
A possible role of the APC/beta-catenin pathway in the pathogenesis of sporadic juvenile nasopharyngeal angiofibroma has been suggested. This paper presents its current status and clinical association in our patients.
A prospective observational study was conducted at King George Medical University and Central Drug Research Institute, in Lucknow, India. Western blot analysis was undertaken in 16 cases to examine beta-catenin expression. The clinical details were recorded along with follow up observations, to determine associations.
Up-regulation of beta-catenin expression was seen in 69 per cent of cases. The clinical variables did not reveal significant differences between patients with extremes of expression (extreme under- vs over-expression). However, absent expression was shown exclusively in young adults aged over 18 years, while enhanced expression was associated with an altered facial profile.
Although a beta-catenin association was seen in a subset of our sporadic juvenile nasopharyngeal angiofibroma cases, its expression was not homogeneous. This is in contrast to the Western literature that suggests a universal (homogenous) enhanced expression in the majority. Hence, further research is required to better define its molecular cascade.
This study was designed to assess anti-diabetic potential of goat, camel, cow and buffalo milk in streptozotocin (STZ) induced type 1 diabetic albino wistar rats. A total of 48 rats were taken for the study where one group was kept as non-diabetic control group (8 rats) while others (40 rats) were made diabetic by STZ (50 mg/kg of body weight) injection. Among diabetic rats, a control group (8 rats) was kept and referred as diabetic control whereas other four groups (8 rats each) of diabetic rats were fed on 50 ml of goat or camel or cow or buffalo milk for 4 weeks. All the rats (non-diabetic and diabetic) were maintained on standard diet for four weeks. STZ administration resulted in enhancement of glucose, total cholesterol, triglyceride, low density lipoprotein, HbA1c and reduction in high density lipoprotein in plasma and lowering of antioxidative enzymes (catalase, glutathione peroxidase and superoxide dismutase) activities in pancreas, kidney, liver and RBCs, coupled with enhanced levels of TBARS and protein carbonyls in pancreas, kidney, liver and plasma. OGTT carried out at the end of 4 week milk feeding indicated that all milks helped in early maintenance of glucose level. All milks reduced atherogenic index. In camel milk fed diabetic group, insulin concentration enhanced to level noted for non-diabetic control while goat, cow and buffalo milk failed to restore insulin level. HbA1c level was also restored only in camel milk fed diabetic group. The level of antioxidative enzymes (catalase, GPx and SOD) in pancreas enhanced in all milk fed groups. Camel milk and to a reasonable extent goat milk reduced formation of TBARS and PCs in tissues and blood. It can be concluded that camel milk ameliorates hyperglycaemia and oxidative damage in type-1 diabetic experimental rats. Further, only camel milk completely ameliorated oxidative damage in pancreas and normalised insulin level.
Background: Spinal Cord Injury Without Radiological Abnormality (SCIWORA) is underreported and poorly recognized in adults. This entity is an important subtype of spinal cord injury (SCI) with relatively good outcomes. Despite this, few studies have been performed to determine specific imaging-related prognostic factors. Methods: A retrospective review of adult patients with cervical SCI admitted to two University hospitals from January 2000 to December 2010 was performed. Only patients with an MRI performed within 72 hours after trauma were included. All patients with bony injury or traumatic malalignment were excluded. Data gathered on the remaining patients included demographics, mechanism of injury, severity of SCI, long-term patient outcome, improvement in neurological condition and MRI results. Results: 49 patients selected. Patients with extramedullary hemorrhage showed worse neurological status at initial examination. Disruption of either the anterior longitudinal ligament or ligamentum flavum was associated with worse outcomes at initial examination and at 1-year follow up. Lesion length was also significantly associated with outcomes at 1 year evaluation and initial evaluation. Conclusions: Early MRI has an important prognostic value in patients suffering SCIWORA. Lesion length is a powerful predictor of outcome. Soft tissue injury and spinal cord changes play a role in the severity of injury as well as the ability to recover.